ORGANIZATIONAL STRUCTURE

PERFORMANCE MANAGEMENT

To be successful in work life; being willing to take more responsibility, adopting promptly to changes and taking lessons from the experience are necessary. From the beginning of your career journey to higher levels, tracking your performance management is one of the key points to be succeeded.

We measure the contributions made to its mission by our employees at each level by using a contemporary performance evaluation and management system, and allow them to improve their performance by providing the required training, exchange of experience, support and guidance.

You have to be positive and willful to own your career path. We can help you to have an unique career plan and it is important to remember that the key point starts from yourself, your vision and your motivation.

Through the performance management you are able to observe how you proceed, where you are today and where you want to be tomorrow. We do our best to match your individual success with the corporate aims.

Focusing on humanitarian values, honesty, transparency, making decisions based on shared wisdom, “open door” management, exploring new ways of working more efficiently and accurately, focusing on opportunities and determination to learn and develop further are the key culture of our organization.

Starting is an important step. Career is not a target to achieve, it is a life-long journey.

TRAINING AND DEVELOPMENT

We value our employees and give importance to their development. Although instant changes and challenging situations encountered today are much more than in the past, our employees can pursue personal and professional growth as well as a long term career with us.

Within the framework of establishing long term career with our employees, we strive for assigning our mid-level and senior managers by promoting our own employees who have fully demonstrated their contribution, proven their competencies and compliance to the corporate culture.

This approach has played a major role in our successful history of 35 years. To continue on this path, we value our “Management Trainee Program”. Within this scope, a 6-steps program is implemented and contributes to the development of our employees with respect to Er-Kim’s Values, Personal Management, Customer Management, Team Management, Sales Performance Management, Challenge Management to meet the possible needs for managers and to maximize the level of our success in the pharma sector.

Along with on-the-job training, dual feedback and guidance, we provide trainings to our manager candidates on the below topics as well:

Through these steps we expect our employees who are included in the Management Trainee Program, to improve their managerial and professional competencies.

In today’s conditions, it is very important for individuals to develop themselves in every challenge and be fully confident of themselves. Of course trainings are important and valuable, on the other hand it is proven by scientific data that “we learn best by practicing” and analyzing how we reach to a point rather than ending up that point.

JOB APPLICATION FORM

Welcome to Er-Kim Pharmaceuticals’ employment site. Thank you for considering us as a potential employer. The Er-Kim team is dedicated to meeting the company's goal - to enhance the quality of life patients through bringing novel therapies into Turkish market. If you are interested in joining our team, please fill the form below:

ALL PRODUCTS

LEADERSHIP

Er-Kim Ilac Sanayi ve Ticaret A.S. is a privately owned company established in 1981 by Seval Family.

Er-Kim Ilac was the first company to bring imported finished form oncology products to Turkey and has continued to be one of the strongest players of this segment for many years.

Er-Kim Ilac, known as the “Company of Firsts”, has imported and introduced many specialty products for physicians’usage in order to fulfill the “unmet needs” in Turkey and has taken a leading part in the treatment of important diseases during the 35 years it has existed in the Turkish pharmaceutical industry.

Over the years, Er-Kim Ilac has presented to the Turkish market life-saving original/patented products of many international companies that bring great value to patients’ lives and has distinguished itself with a consistent record of success. These successes led the way for the main companies to establish their own organizations in Turkey and grow even further.

“Introducing new and cost-effective treatment alternatives to Turkey” being its key mission, Er-Kim Ilac plans and executes all its activities based on this quest. Er-Kim Ilac puts on great effort to introduce the unavailable treatment alternatives in Turkey into the service of healthcare professionals and thereby patients, and also contributes to public healthcare savings by adding the affordable equivalents of the products to its portfolio within the scope of domestic contracted manufacturing agreements.

Er-Kim Ilac has achieved remarkable successes and presented many new concepts with the innovative products that it has introduced especially in the fields of Hematology and Oncology.

Er-Kim Ilac continues to present imported Rx-only pharmaceutical products into the service of Turkish Medicine while also endeavoring to look after added values for patients/physicians and extends its portfolio with generics, medical devices, food supplements and over-the counter products.

Er-Kim Ilac has decided to enlarge its business in nearby countries through using the knowledge, experience and human resources it has gained until now and has already taken the first steps on this aim.

As of today, continuing to be the exclusive distributor of the drugs, medicinal devices and over-the-counter products of 11 international companies and having introduced its domestically manufactured products into the Turkish market, Er-Kim Ilac strives to meet the needs of the medicine and pharmaceutical industries and continues to take firm steps forward to bring added value to human life.

DISCLAIMER

The information in this site is not intended to replace the advice of a doctor or a pharmacist. In the case that the information and references being misused in this site, errors and absences in the content and in any conditions that will be formed as a result of using the site, Er-Kim Ilac does not take the legal responsibility. The information in the site is directed only to the target users, these information cannot be distributed, copied, forwarded to the third persons/groups by other persons. Use without permission of the officially registered brands and the texts mentioned in the site is forbidden. For the update of the site Er-Kim Ilac works carefully but cannot give any engagement and guarantee. For the use of the site the users are considered to have agreed on the legal warning above totally and without reservation.

The information in the site that are connected by the links that take part in this site is out of the responsibility of Er-Kim Ilac. The activities in these sites may not be conformed to the regulations set out by the Republic of Turkey and the information may be different from the texts that are approved by the Republic of Turkey Ministry of Health.

COMMUNICATION FORMS

To apply for a carreer at Er-Kim Pharmaceuticals, please fill out the application form.

We advise you to consult your physician or pharmacist about the medications you take, your diseases and the treatment options. We would like to inform you that we will not be able to answer your questions about these subjects, according to the Turkish Ministry of Health’s regulations.

If you are concerned that you have had a suspected adverse reaction to a medicine, you may consult your physician or your pharmacist. You can select “Adverse Reaction Notification Form” below to report us.
You may also report your adverse reaction directly by using “Drug Adverse Reaction Notification” link that was linked under Turkish Ministry of Health’s web site www.titck.gov.tr or by calling directly at + 9 0 800 314 00 08.
In emergency situations, you may contact Delta PV, the Drug Safety authority of Er-Kim Pharmaceuticals, at number + 9 0216 385 93 33 or you may report by e-mail at pv@deltapv.com

Please feel free to contact us by choosing appropriate subject on the below forms regarding your comments, recommendations and business development.

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BUSINESS DEVELOPMENT

With more than 35 years experience, we have made great collaborations, and we are continuing to improve with new partnerships.

From America to Europe, from Japan to Turkey, Er-Kim has worldwide partners and is committed to enlarge its portfolio through engaging further.

VISION · MISION · VALUES

Since its foundation, Er-Kim Ilac adopted a transparent approach philosophy with its product portfolio and works for the health of Turkish citizens. It ensures that innovative products, high biotechnology products and innovative food supplements are accessible in the Turkish market.

Existing for more than 35 years, Er-Kim Ilac has brought many important and supportive products into Turkey by introducing new treatment options, and continues to take firm steps forward to achieve its aim of improving human health as a company that invests in the future of health and offers transparent and innovative services.

Er-Kim Ilac’s management system depends on open communication and gives particular importance to humanitarian values.

Er-Kim Ilac integrates each experience it has gained to the future to develop plans to work more productively and effectively and to change its organizational structure if necessary, and has set out its principles to differentiate itself by working in accordance with its company philosophy that continuously analyses the market dynamics and needs to adapt accordingly and values its employees’ opinions. Adopting a management system that is open to change and improvement, Er-Kim Ilac has been quite successful in managing the internal and external customers and also each step of the interactive process chain in accordance with today’s conditions.

TREATMENT AREAS

Hematology

What is Myelodysplastic Syndrome?

Myelodysplastic Syndromes (MDS) are a group of diverse bone marrow disorders where the bone marrow cannot produce enough healthy blood cells. Although MDS primarily occur in the elderly, younger individuals can also be affected.

Low blood cell counts, referred to as cytopenias, are the most common sign of MDS; infections due to low white blood cell counts, anemia due to low red blood cell counts, and spontaneous bleeding or easy bruising due to low platelet counts can be seen in patients with MDS.

The treatment of MDS is determined based on the symptoms, disease stage, disease risk category, patient’s age and co-morbidities. Although various treatments are available for MDS, not all of them are appropriate for each patient.

New drug therapies (hypomethylating agents) targeting biological mechanisms that play a role in the development of myelodysplastic syndrome have yielded successful treatment results during recent years.

What is Multiple Myeloma?

Multiple Myeloma is a malign disease that develops as a result of uncontrolled growth of the plasma cells. Malignant plasma cells that form in multiple myeloma are called myeloma cells. Myeloma cells produce an abnormal antibody of a single type (monoclonal). Multiple Myeloma causes anemia, infections, weak bones and kidney damage.

Treatment is planned considering the patient’s age, physical condition, organ functions and personal preferences. The “new drugs” now available for treatment and stem cell (bone marrow) transplantation recently yielded improved results in the treatment of this disease.

What is Hemophilia?

Hemophilia is an inherited blood disorder which presents with continuous bleeding due to life-long absence or deficiency of the blood factors responsible for clotting, namely factor 8 (VIII) and factor 9 (IX). Factor 8 deficiency and factor 9 deficiency are called Hemophilia A and B respectively.

Hemophilia is inherited, not contagious. It occurs in male family members while females are carriers.

In hemophilia patients, excessive bleeding occurs in various parts of the body. The extent of bleeding varies according to the blood levels of factor 8 and 9. Male children before the age of 2 usually experience bruises on arms and legs, and painful swelling of joints such as knees and elbows due to bleeding following bumps and falls. Prolonged nose bleeding, gum bleeding, bleeding following circumcision and delayed wound healing are the other significant complaints.

Depending on disease severity, bleeding remains for life in patients with hemophilia. Clinical presentation can be severe based on the factor level. Patient’s history and laboratory tests are essential for diagnosing hemophilia.

The main treatment approach in such patients is factor replacement therapy to ensure that sufficient levels of Factor 8 or Factor 9 are maintained in the plasma. The treatment is life-long.

The current high quality standards and product safety methods significantly reduce the risks relating to the products that are used in the replacement therapy, the most important issue being development of inhibitors against the products that are used in the treatment of hemophilia patients. Inhibitor development occurs when the body recognizes the given coagulation factors as a foreign substance and produces antibodies that neutralize them. Hemophilia patients who develop inhibitors respond only to high doses of in some cases do not respond to the treatment.

What is Idiopathic Thrombocytopenic Purpura?

Immune Thrombocytopenic Purpura, also called ‘Idiopathic Thrombocytopenic Purpura’ (ITP), is an autoimmune disease characterized by abnormal clotting and tendency for bleeding. In ITP, the antibodies accidentally produced in the body against the platelets (thrombocytes or clotting cells) damage the platelets and cause tendency for bleeding.

There are acute (sudden onset) and chronic (persistent) types of ITP. Acute ITP typically develops following infections and usually resolves within six months. Acute form is commonly seen in children. Disease persisting more than six months is called Chronic ITP, which is more often seen in adults.

The patients may present with skin bruises, petechias (pinpoint-sized bleeding spots that do not fade by pressing on the skin or in mouth), prolonged bleeding, nose bleeding, gum bleeding, heavy menstrual bleeding, blood in urine or in stool.

Diagnosis is established by the patient’s medical history, physical examination, complete blood count and peripheral blood smear. The majority of child patients recover spontaneously within 6 months, only few progress to the chronic type. Most of adult patients are chronic and require treatment.

What is Secondary Immune Deficiency?

The immune system defends the body against the harmful effects of microorganisms that may cause infections, such as bacteria, viruses, fungi or parasites. Immune deficiencies develop as a result of a deficiency in one or more components of the immune system.

Immune system deficiencies defined as Secondary Immune Deficiencies (SIDs) are a group of disorders that secondarily develop due to conditions such as some chronic diseases other than hereditary causes, cancers, use of drugs that are toxic to bone marrow, prolonged use of corticosteroids, infections affecting the immune system such as AIDS, interventions such as bone marrow transplantation, some metabolic disorders, severe hepatic failure, severe malnutrition, uremia, severe or large burns.

The most important diseases leading to secondary immune deficiency include Multiple Myeloma (MM) and Chronic Lymphocytic Leukemia (CLL).

Multiple Myeloma is a malign disease that develops as a result of uncontrolled growth of the plasma cells. Malignant plasma cells that form in multiple myeloma are called myeloma cells. Myeloma cells produce an abnormal antibody of a single type (monoclonal).

Leukemia is a type of cancer that presents with abnormally increased blood cells, particularly the white blood cells. CLL is the most common type of leukemia in adults. CLL is seen more often in people older than 60 years. CLL is a slow-growing cancer, therefore it generally does not cause much clinical signs at early stages, it is asymptomatic. The most common finding on physical examination is swelling of the superficial lymph nodes. Sometimes fever, weight loss, weakness and fatigue can be seen. The spleen and liver can be enlarged in later stages.

The most common cause of morbidity and deaths in CLL patients is infections while the most common cause of infections is hypogammaglobulinemia resulting from immune deficiency. In advanced stages, infections associated with immune deficiency, bone marrow infiltration, chemotherapy and neutropenia due to hypersplenism occur frequently.

What is Iron Deficiency Anemia?

Iron is located in the hemoglobin of the red blood cells. Iron deficiency anemia is defined as hemoglobin levels in the blood below the normal range according to the age and gender due to reduced iron levels in the body.

Iron deficiency anemia occurs in cases of insufficient dietary intake of iron or malabsorption of iron despite sufficient dietary intake, in cases where the need to iron is increased such as pregnancy or childhood, or in cases of blood loss in the gastrointestinal system or other systems.

Symptoms such as weakness, loss of appetite, persistent headache, numbness in the limbs, shortness of breath, palpitations, burning sensation in the mouth and tongue, cracking at the edges of the mouth or dysphagia can be seen in iron deficiency anemia. Severe iron deficiency anemia can lead to cardiac problems, infections, growth or development problems in children and other complications. It can cause conditions such as preterm or low-weight delivery or blood transfusion need after delivery.

Oncology

Medical Oncology

What is Bone Metastasis?

Bone metastasis is the spread of cancer cells from the primary tumor to the bone. In general, cancers of prostate, breast, lung, thyroid and kidney are most likely to spread (metastasize) to the bones. Clinical presentation of bone metastases is variable; most common findings are bone pain, fractures and spinal cord compression.

While the incidence of pain among cancer patients is 38% in early phases of the disease, this ratio increases up to 85% as the disease progresses and the quality of life is diminished. Although the chronic cancer pain can be controlled successfully with opioid analgesics in patients with medium or severe cancer pain, a great number of patients may experience a sudden onset of transient breakthrough pain associated with movement, which may be repeated several times a day.

Studies have shown that breakthrough pain may occur frequently in cancer patients and has an impact on the quality of life. A study has demonstrated the incidence of breakthrough pain as 64% among cancer patients. Breakthrough pain is the transient pain attack that flares up although the patient is on regular pain treatment. Usually the pain has a sudden onset and subsides within a few minutes to a few hours. Many patients experience multiple instances of breakthrough pain within the day.

Breakthrough pain may result from the cancer or the cancer therapy or may occur during a certain activity (like walking, dressing or coughing). However, it may also occur unexpectedly and without a reason. Breakthrough pain usually requires stronger painkillers with a more rapid effect than the chronic pain management medication.
Although this pain is directly linked with the invasion and compression of the tumour (85%), it is also associated with the tumour treatment in 17%, with the tumour in 9% and non-tumour causes in 9%.

In conclusion, cancer pain occurs in the form of continuous or intermittent pain or flares (sudden increase in pain intensity – breakthrough pain). Breakthrough pain observed in 2/3 of the cancer patients occurs especially during swallowing, coughing, defecation or micturition and it is severe, short-lived and difficult to control. Pain medication with short-term effect in addition to the basic medical therapy of the patient may help the pain relief.

What is Chemotherapy Induced Nausea and Vomiting?

Nausea and vomiting are among the most common side effects of the chemotherapy medication used in cancer. The nausea and vomiting occur due to the cellular damage caused by the chemotherapy agents on the digestive system.

The potential of the chemotherapeutic agents used in cancer treatment to cause nausea and vomiting, the dose of these drugs and the individual differences determine the clinical condition of the patient.

Nausea and vomiting due to chemotherapy has different types: Acute nausea and vomiting (within the first 24 hours after the administration of the chemotherapy), late-onset nausea and vomiting (observed between 24-120 hours or the 2nd to 5th days) and the learned or anticipatory nausea and vomiting. The patient’s anticipation after a nausea and vomiting experience following a previous chemotherapy session may increase the incidence of nausea and vomiting in that patient.

Medical treatment is of utmost importance in the optimum control of the nausea and vomiting due to chemotherapy. There are currently various agents used to prevent or treat nausea and vomiting. Prevention of nausea and vomiting is equally important as their treatment. In order to prevent the occurrence of nausea and vomiting, the patient receives prophylactic treatment before the chemotherapy session. The characteristics of the chemotherapy agent inducing nausea and vomiting, any previous medications that have caused nausea and vomiting in the patient and the efficiency of these therapies are factors that need to be considered in the planning of the treatment against nausea and vomiting.

Immunology

What is Primary Immune Deficiency?

The immune system defends the body against the harmful effects of microorganisms that may cause infections, such as bacteria, viruses, fungi or parasites. Immune deficiencies develop as a result of a deficiency in one or more components of the immune system.

Immune system deficiencies defined as Primary Immune Deficiencies (PIDs) are a group of hereditary diseases. The expected frequency in Turkey is higher than Europe or USA due to higher frequency of kin marriages.

The common clinical signs of primary immune deficiencies are increased susceptibility to infections and having frequent infections. Long lasting infections, unusually frequent infections, infections that show incomplete response to treatment, recurrent skin rash, developmental delay, long lasting diarrhea, recurrent abscess (wounds) are signs that suggest immune deficiency. This diagnosis should be considered in children who have such features in their history.

Early diagnosis and treatment are essential procedures regarding morbidity and mortality. In such patients, the most important treatment approaches are to strengthen the body, to protect the body from infectious agents and to replace the missing immune components using plasma derivatives obtained from healthy individuals.

What is Secondary Immune Deficiency?

The immune system defends the body against the harmful effects of microorganisms that may cause infections, such as bacteria, viruses, fungi or parasites. Immune deficiencies develop as a result of a deficiency in one or more components of the immune system.

Immune system deficiencies defined as Secondary Immune Deficiencies (SIDs) are a group of disorders that secondarily develop due to conditions such as some chronic diseases other than hereditary causes, cancers, use of drugs that are toxic to bone marrow, prolonged use of corticosteroids, infections affecting the immune system such as AIDS, interventions such as bone marrow transplantation, some metabolic disorders, severe hepatic failure, severe malnutrition, uremia, severe or large burns.

The most important diseases leading to secondary immune deficiency include Multiple Myeloma (MM) and Chronic Lymphocytic Leukemia (CLL).

Multiple Myeloma is a malign disease that develops as a result of uncontrolled growth of the plasma cells. Malignant plasma cells that form in multiple myeloma are called myeloma cells. Myeloma cells produce an abnormal antibody of a single type (monoclonal).

Leukemia is a type of cancer that presents with abnormally increased blood cells, particularly the white blood cells. CLL is the most common type of leukemia in adults. CLL is seen more often in people older than 60 years. CLL is a slow-growing cancer, therefore it generally does not cause much clinical signs at early stages, it is asymptomatic. The most common finding on physical examination is swelling of the superficial lymph nodes. Sometimes fever, weight loss, weakness and fatigue can be seen. The spleen and liver can be enlarged in later stages.

The most common cause of morbidity and deaths in CLL patients is infections while the most common cause of infections is hypogammaglobulinemia resulting from immune deficiency. In advanced stages, infections associated with immune deficiency, bone marrow infiltration, chemotherapy and neutropenia due to hypersplenism occur frequently.

What is Kawasaki Disease?

Kawasaki disease (KD) is a self-limiting systemic vascular disease (vasculitis) with acute onset that causes inflammation in the walls of arteries, which can lead to aneurysms (balloon-shaped bulging of the vessel) in vessels of the heart (coronary vessels).

Eighty-five percent of patients who have Kawasaki disease are younger than 5 years. Kawasaki disease is more frequent in male children.

Key symptoms are remittent fever persisting for 1-2 weeks and other symptoms such as conjunctivitis, lesions of mouth and lips, rashes in hands and feet, and enlarged lymph nodes.

Since the cause of the disease is not well known, diagnosis is possible with the patient’s history and clinical findings. Unexplained fever lasting minimum 5 days and the other clinical findings are essential for diagnosis. Electrocardiography (ECG) and echocardiography should be obtained if Kawasaki disease is suspected.

Development of coronary artery (vessels that supply the heart) abnormalities in 20-25% of untreated patients indicates the importance of the disease. Risk of coronary artery abnormalities can be reduced by early diagnosis and treatment.

Neurology

What is Guillain-Barré Syndrome?

Guillain-Barré Syndrome (GBS) involves the nervous system and is an autoimmune nervous system disease associated with abnormal functioning of the immune system. It occurs when the immune system is triggered immediately after a viral infection causing destruction and loss of the myelin sheath of nerve cells. It most commonly develops after upper respiratory infections (flu) or intestinal infections (diarrhea), occasionally it can be triggered by a vaccine.

Anyone can get GBS but it is slightly more common in older age. Nerve conduction decreases and slows down in GBS. Guillain-Barre Syndrome usually has a sudden onset, with muscle weakness, which is the primary finding, starting from the lower part of the body that progress upwards. Occasionally, first signs of the disease can be abnormal sensations such as pain, ache, numbness or tingling. Weakness is mild at the start, rapidly progresses to involve legs, arms and face in a few days or hours. Patients have difficulty holding objects such as comb, pen or buttons due to weakness and numbness on hands and fingers.

Treatment should be initiated immediately once the diagnosis is confirmed.

What is Myastenia Gravis?

Myastenia Gravis (MG) is a chronic, complex, autoimmune disease characterized by muscle weakness and fatigue. MG is usually seen in women at 20-30 years of age and men over 50.

Typical signs and symptoms are muscle weakness that is increased by exercise and late afternoon and decreased by resting. Initial symptoms are usually double vision, drooping eyelids, difficulty swallowing, chewing and talking. In 1-3 years of onset, weakness involves respiratory, trunk, arm and leg muscles in majority of the patients. Patients should be treated in an intense care unit if the serious clinical form called “Myasthenic crisis” occurs. Infections and fever, excessive physical activity, thyroid gland diseases and pregnancy can trigger and worsen MG.

The significant findings on neurological examination are difficulty maintaining muscle movements and fatigue. Additionally, ACh antibody tests and abnormalities related to the thymus gland are investigated.

Majority of the patients can maintain a normal life with a well-informed, close follow-up and treatment.

What is Chronic Inflammatory Demyelinating Polyradiculoneuropathy?

Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is a disease that affects the peripheral nerves, which conduct signals for movement and sensations such as touch, pain or heat. CIDP occurs when the immune system attack the myelin sheath of nerve cells. What causes this process is not yet known.

It can be observed at any age, including children and elderly. However, it occurs most frequently in men aged 40-60 years.

The disease presents with progressive, two-sided, symmetric loss of sensations and muscle weakness. If the weakness and sensation loss are progressive and persist more than 8 weeks, CIPD should be considered. The slow progression differentiates CIDP from GBS. Face and neck muscles can be involved, tingling and numbness can occur on hands and feet. Instability can be seen in many cases. Muscle weakness progress with attacks of worsening following periods of temporary improvement. It has two clinical patterns; chronic progressive and relapsing-remitting.

Multifocal Motor Neuropathy (MMN) is a progressive neuropathy with asymmetric, slow onset weakness. MMN is a chronic, rare and underdiagnosed disease. It occurs less frequently compared to GBS and CIPD. Average age of onset is the mid-fifties. Men are more likely to be affected.

It occurs more frequently in the arms than legs. Weakness commonly begins in the distal arm. As the condition worsens, muscle atrophy occurs besides nerve damage and weakness becomes more symmetric and generalized. Reflexes in the affected regions diminish in time. Sensory symptoms and findings are generally absent or clinically insignificant.

Urology

What is Overactive Bladder?

Overactive bladder is sudden and involuntary contracting of the bladder as the bladder is filled with urine from the kidneys. It is characterized by frequent voiding and nighttime voiding (with or without leakage).

Incontinence (urine leakage) does not necessarily occur in every patient with overactive bladder. Incontinence is a condition seen in 25% of all women over 30 years.

Treatment options are behavioral, medical and surgical therapies. The primary element of behavioral therapy is Kegel exercises aimed to relax the bladder. Medical therapy includes anticholinergic drugs that provide relaxation of the bladder. Certain antidepressants can also be used to treat OAB. In more resistant cases, Botox can be used for bladder relaxation. Surgical treatment is considered only for seriously affected patients who do not respond to medical treatments.

What is Benign Prostatic Hyperplasia?

Benign Prostatic Hyperplasia (BPH) is a benign enlargement of the prostate gland. The two main factors for prostate enlargement are age and the male hormone. Patients often present with complaints of frequent voiding at night, weak or interrupted voiding, straining to urinate, split stream during voiding, difficulty starting to urinate, blood in urine, feeling of incomplete emptying of bladder, incontinence (urgency or dribbling) or inability to urinate.

Medical treatment involves two drug groups: alpha reductase inhibitors; they reduce the size of the prostate by blocking an enzyme in the prostate but their effects are relatively slow. Alpha-receptor blockers mainly affect the smooth muscles of the prostate; prostate contains extensive smooth muscle cells, which have a role in the prostatic enlargement. This drug group acts faster. However, currently TUR-P operation, also known as closed prostate operation, is also used to treat such patients.

Gynecology & Obstetrics

What is Healthy Nutrition in Pregnancy?

Every mother-to-be should have a regular diet containing foods rich in vitamins and minerals in order to maintain healthy growth of the baby and her own vitamin and mineral levels. Folic acid is not stored in the body; its deficiency may cause serious neural tube defects in the baby. Iron deficiency causes anemia of the mother, which may cause the risk of low birth weight. If iodine deficiency causes hypothyroidism in the mother, the baby can be born with certain abnormalities and mental retardation or learning difficulties can occur in the coming years.

Ginger is an effective remedy to relieve nausea and vomiting of pregnancy. Ginger has no known adverse effects on the fetus or the pregnant women.

Probiotics are microorganisms that have favorable effects on health and well-being of the recipient when consumed in sufficient amounts. Probiotics are thought to be safe in pregnancy, and there are scientific publications that suggest that they strengthen the immune systems of both the mother-to-be and the developing baby.

Probiotic consumption was shown to prevent allergic diseases such as atopic dermatitis, asthma, hay fever in children and significantly reduce the rates of gestational diabetes.

What is Iron Deficiency Anemia?

Iron is located in the hemoglobin of the red blood cells. Iron deficiency anemia is defined as hemoglobin levels in the blood below the normal range according to the age and gender due to reduced iron levels in the body.

Iron deficiency anemia occurs in cases of insufficient dietary intake of iron or malabsorption of iron despite sufficient dietary intake, in cases where the need to iron is increased such as pregnancy or childhood, or in cases of blood loss in the gastrointestinal system or other systems.

Symptoms such as weakness, loss of appetite, persistent headache, numbness in the limbs, shortness of breath, palpitations, burning sensation in the mouth and tongue, cracking at the edges of the mouth or dysphagia can be seen in iron deficiency anemia. Severe iron deficiency anemia can lead to cardiac problems, infections, growth or development problems in children and other complications. It can cause conditions such as preterm or low-weight delivery or blood transfusion need after delivery.

Overactive bladder is sudden and involuntary contracting of the bladder as the bladder is filled with urine from the kidneys. It is characterized by frequent voiding and nighttime voiding (with or without leakage).

Incontinence (urine leakage) does not necessarily occur in every patient with overactive bladder. Incontinence is a condition seen in 25% of all women over 30 years.

Treatment options are behavioral, medical and surgical therapies. The primary element of behavioral therapy is Kegel exercises aimed to relax the bladder. Medical therapy includes anticholinergic drugs that provide relaxation of the bladder. Certain antidepressants can also be used to treat OAB. In resistant cases, Botox can be used for bladder relaxation. Surgical treatment is considered only for seriously affected patients who do not respond to medical treatments.

What is Osteoporosis?

Osteoporosis, also known as bone thinning, is the most common bone metabolism disease characterized by reduced bone mass. As a result of reduced mass and quality, bones can easily break.

The bone mass begins to gradually decrease after approximately 40 years of age. This loss is accelerated in women after menopause due to reduced estrogen levels. Therefore, women are at higher risk for osteoporosis compared to men.

The most common method to diagnose osteoporosis is measurement of bone density. Treatment can be planned according to measurement results.

A healthy diet, sufficient exposure to sunlight and regular exercise are essential to prevent osteoporosis. Additionally, calcium and vitamin D supplementations and drugs that prevent osteoporosis are often used as recommended by a doctor.

Hepatitis B infection can be acute or chronic. Hepatitis B infection lasting more than six months is defined as chronic Hepatitis B disease. Chronic infection generally persists a lifetime and may cause liver failure, cirrhosis or liver cancer.

What is Ulcerative Colitis?

Ulcerative colitis is a disease of the large intestine (colon). Ulcerative colitis is the disease of the inner layer (mucosa) of the colon. Inflammation and bleeding wounds (ulcers) occur in the mucosa.

Lower section of the colon (rectum) is affected in almost all of the patients. Some patients may have the disease in a larger portion of the large intestine while colon may be totally involved in some patients. In other words, the extent of the disease differs from person to person.

The cause of ulcerative colitis is unknown. Various food contents, bacteria, bacterial toxins, viruses may have a role in its development. However, there are no food or microbes found responsible. In response to a harmful factor, inflammatory cells in the intestinal mucosa increase, inflammation and ulcers develop.

Patient history including large intestine bleeding accompanied by diarrhea (or constipation) and abdominal pain suggests ulcerative colitis. Once intestinal infection is ruled out by stool and blood tests, the diagnosis should be confirmed by colonoscopy (or initially rectoscopy).

Hepatitis B infection can be acute or chronic. Hepatitis B infection lasting more than six months is defined as chronic Hepatitis B disease. Chronic infection generally persists a lifetime and may cause liver failure, cirrhosis or liver cancer.

What is Liver Transplantation?

Liver transplantation is required when liver damage seriously affects the well-being and life-quality of a patient. Currently, liver transplantation is theoretically the most effective mode of treatment for all diseases that lead to liver failure.

Liver transplantation is replacing the damaged liver in selected cases with chronic liver disease or acute fulminant failure, with normally functioning liver parts obtained from healthy individuals or people who had brain death. Liver failure is a life-threatening condition. Individuals whose life expectancy is less than 10% without a liver transplant get a 90% probability of survival after liver transplantation.

In our country, hepatitis B virus is the most common cause of liver failure. Liver failure may recur if hepatitis B infection relapses after liver transplantation. Therefore, it is essential to monitor the transplanted liver for hepatitis B virus infection with appropriate treatment and follow-up.

Dermatology

What is Leprosy (Hansen’s) Disease?

Leprosy bacillus was discovered by Armauer Hansen, a Norwegian scientist, in 1876. It is a chronic infectious disease primarily affecting the skin and nervous system. According to World Health Organization data, there are approximately 4 million leprosy patients worldwide; 2589 patients are present in Turkey. It is most common in populations with insufficient access to healthcare services.

The disease is most common in multi-child families; infection spreads easily in families who live in a single room, eat from the same can, and have poor diet and low immunity. The disease affects both genders.

The bacillus is closely related to tuberculosis bacillus and the disease can develop in case of long-term close contact with an infected individual in the absence of natural immunity against the germ. The human being is the only known reservoir of infection. Cure is possible with early diagnosis and treatment. Leprosy is a reportable disease.

Endocrinology

What is Diabetes Mellitus?
Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces.
Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia).

Types of Diabetes:
1. Type 1 Diabetes (insulin-dependent)
2. Type 2 Diabetes (non-insulin dependent diabetes or adult-onset diabetes, and accounts for at least 90% of all cases of diabetes)
3. Gestational diabetes (GDM) is a form of diabetes consisting of high blood glucose levels during pregnancy
4. Other specific types

Complications of Diabetes
Consistently high blood glucose levels can lead to serious diseases affecting the heart and blood vessels, eyes, kidneys, nerves and teeth. In addition, people with diabetes also have a higher risk of developing infections. Diabetes is a leading cause of cardiovascular disease, blindness, kidney failure, and lower limb amputation.
Treatment for Diabetes is either insülin or oral anti-diabetics. Besides, the complications of diabetes shall also be monitored closely and necessary actions shall be taken to prevent or treat diabetes related complications.

What is Central Diabetes Insipidus?The production or action of antidiuretic hormone that ensures absorption of water in the kidneys and controls the amount of urine is reduced in patients with diabetes insipidus. Antidiuretic hormone (ADH) is also called arginine vasopressin (vasopressin). In the deficiency of antidiuretic hormone, which is responsible for concentrating the urine in the kidneys; patients present with excessive amounts of urine and extreme thirst. Patients with diabetes insipidus can have approximately 4 to 20 liters of urine and can drink the same amount of water.

Antidiuretic hormone secretion from the pituitary gland is not sufficient in the majority of patients with diabetes insipidus. This condition is called “central diabetes insipidus”. Pituitary and hypothalamic diseases cause central diabetes insipidus.

Ophtalmology

Birdshot retinochoroidopathy (BRK) is a chronic disease of the posterior pole of the eye. It cause is unknown. However, an autoimmune reaction to retinal antigens is though to have a major role.

BRK is an inflammatory disease that involves both eyes symmetrically and is characterized by multiple, diffusely scattered, cream-colored depigmentation foci in the fundus. The general condition of patients, of which two-thirds are females, are good. The disease is seen between the ages of 40 to 65.

BRK is a chronic disease with exacerbations and remissions and can cause severe vision loss. Patients see floaters associated with more or less change in their vision. Photophobia, change in color vision and nyclalopia are also seen.

The most common complication is cystoid macular edema which is seen more than half of patients.

Intensive Care

What is Albumin Deficiency?

Albumin is the most common protein found in the human blood plasma. It accounts for 60% of all proteins found in the blood. It is also found in tissue fluids, mainly in muscle and skin, and, in small amounts, in tears, sweat, gastric juice and bile. 30 to 40% of the total albumin in the body is found in the blood. In addition to transporting fatty acids and various other substances in the blood, the most important function of albumin is to maintain a proper water balance between the blood and tissue fluids.

Large proteins balance the leakage trend of the fluids in the blood since they cannot cross the capillaries. Albumin is therefore the main protein to regulate the colloid osmotic pressure, or oncotic pressure, that causes water and water-soluble substances to cross tissues from the capillaries. 70% of the oncotic pressure is exerted by albumin, therefore albumin is required for fluid balance between inside of the blood vessels and the external tissues. If the blood protein levels decrease, for example in the case of loss of protein to the urine (proteinuria), insufficient albumin production by the liver, malnutrition, or albumin loss from the body due to severe burns, “edema” (i.e water accumulation in the tissues) occurs.

Albumin binds the fatty acids, drug molecules, free oxygen radicals and various metal ions that can be toxic at high concentrations in the blood, thereby maintaining the consentrations of these substances in the blood at low and harmful levels as well as ensuring them to reach the locations where they are needed. Another feature of albumin is that it is able to partially buffer the blood acidity (pH).

Despite being a life-saving treatment tool, blood plasma is a hard-to-obtain and perishable product. Edwin J. Cohn invented a method for albumin purification from blood plasma in 1940s as a result of the research to find plasma segments that have the useful features of the plasma with additional convenience. It was been that albumin is an excellent material to substitute for blood plasma in certain cases. It is mainly used to increase or keep constant the blood volumes in the cases of severe trauma, surgery, blood loss and burn treatment. It is also used in cases of malnutrition, dehydration, chronic infection, hepatic impairment or renal impairment.

Algology

What is Breakthrough Pain in Cancer Patients?

While the incidence of pain among cancer patients is 38% in early phases of the disease, this ratio increases up to 85% as the disease progresses and the quality of life is diminished. Although the chronic cancer pain can be controlled successfully with opioid analgesics in patients with medium or severe cancer pain, a great number of patients may experience a sudden onset of transient breakthrough pain associated with movement, which may be repeated several times a day.

Studies have shown that breakthrough pain may occur frequently in cancer patients and has an impact on the quality of life. A study has demonstrated the incidence of breakthrough pain as 64% among cancer patients. Breakthrough pain is the transient pain attack that flares up although the patient is on regular pain treatment. Usually the pain has a sudden onset and subsides within a few minutes to a few hours. Many patients experience multiple instances of breakthrough pain within the day.

Breakthrough pain may result from the cancer or the cancer therapy or may occur during a certain activity (like walking, dressing or coughing). However, it may also occur unexpectedly and without a reason. Breakthrough pain usually requires stronger painkillers with a more rapid effect than the chronic pain management medication.
Although this pain is directly linked with the invasion and compression of the tumour (85%), it is also associated with the tumour treatment in 17%, with the tumour in 9% and non-tumour causes in 9%.

In conclusion, cancer pain occurs in the form of continuous or intermittent pain or flares (sudden increase in pain intensity – breakthrough pain). Breakthrough pain observed in 2/3 of the cancer patients occurs especially during swallowing, coughing, defecation or micturition and it is severe, short-lived and difficult to control. Pain medication with short-term effect in addition to the basic medical therapy of the patient may help the pain relief.